Risk factors for childhood asthma deaths from the UK Eastern Region Confidential Enquiry 2001-2006

Background: Confidential enquiries into asthma deaths can identify inadequacies in medical management and factors which contribute to patients' death. Aims: To identify risk factors for paediatric asthma deaths over a 6-year period. Methods: Observational case-series study of paediatric asthma deaths between 2001-2006 in the UK Eastern Region. Hospital, primary care and post-mortem data were obtained for every child (<= 17 yrs) with asthma recorded on the death certificate, and a detailed questionnaire was completed. Information was obtained on asthma severity, medications, hospital admissions, GP and hospital follow-up, adherence, psychosocial / behavioural factors, allergies, details of the terminal attack and precipitating factors. Results: 20 children (10 male; 8-17yrs; median: 11.5yrs) died of asthma between 2001-2006. 9/20 had mild to moderate asthma (BTS/SIGN criteria), 10/20 had severe asthma and 1 child was not known to have asthma. 13/20 were clinically atopic. Only 3 had undergone allergy assessment. 10/20 died between June and August. 12/20 children had adverse psychosocial and behavioural factors. 7/20 children were on non-combination long-acting beta(2)-agonist (LABA) treatment without inhaled corticosteroids (ICS). Conclusions: Almost half the deaths occurred in children with mild/moderate asthma. We recommend that allergic factors and seasonal allergy should be identified early, non-combination LABAs avoided, and speculate that overuse of short-acting beta(2)-agonists (SABAs) may indicate non-adherence with ICS. Asthma deaths in children can be avoided if risk factors are identified early. (C) 2012 Primary Care Respiratory Society UK. All rights reserved. K Anagnostou et al. Prim Care Respir J 2012; 21(1): 71-77 http://dx.doi.org/10.4104/pcrj.2011.00097